Family medicine offices must evolve to survive in today's rapidly changing health care system. Successful office change requires transformation of organizational structure and staff roles. Medical assistants (MAs) are support staff commonly found in family medicine offices that can perform a variety of clinical and administrative tasks. Knowledge about MAs is superficial because their training and skills vary substantially and their roles, which are relatively unregulated, are office specific. It is unclear what activities they currently perform in family medicine offices and how their roles have adapted to meet, evolving office needs. Complexity theory provides a framework to achieve deeper understanding of MA roles through the study of office team relationships. Purpose: This study will describe MA roles and the office system characteristics that direct changes in MA activities through interviews and observations of family medicine office teams. Specific Aims: 1). Describe current and emergent MA roles in family medicine offices using questionnaires, interviews, and observations of family medicine office teams. 2). Assess how MA activities have adapted to meet immediate and enduring office needs through the interviews and direct observations. 3). Develop a conceptual model that describes factors shaping MA roles and activities through analysis of the questionnaire, interview, and observation data. Methods: Six community family medicine offices in the greater Cincinnati region will be purposefully selected. MA roles and factors that direct changes in MA activities will be identified through questionnaires and semi-structured interviews of MAs, clinical supervisors, and physicians and direct observations of MAs performing patient care activities and staff interactions. Interview and questionnaire data will be compared to observation findings to identify MA and office characteristics that influence MA role change. Data will be analyzed iteratively for each office's data set and the summed data by an established ethnographic research team. Results will be presented to a member checking focus group of MAs to ensure trustworthiness. Significance: The results of this pilot study will inform future multi-site investigations of experimental design that will test if family medicine offices can purposefully direct the development of MA roles to support office transformation by controlling office system characteristics and assessing individual MA traits. PUBLIC HEALTH RELEVANCE: Medical assistants (MAs) are essential to most family medicine office teams often assisting doctors as their principle aids, yet there are no comprehensive descriptions of medical assistants'clinical activities. This exploratory investigation will use surveys, interviews, focus groups and observation to identify current medical assistant roles and describe how individual medical assistant traits and office characteristics influence what patient care activities medical assistants perform. The results of this study are necessary for future investigations to test purposefully directed medical assistant development in transforming family medicine offices to improve the quality of patient centered care.